318 THE PORT OF LONDON.—SMALL-POX AT NEWMARKET.

of health. These questions ask for information as to qualitystorage, &c.; the replies to which, if intelligently given, cannot fail to form a nucleus of useful information. As man

places in England are still partially, if not wholly, dependentupon rain-water, the storage question is a matter of grealimportance. it is, of course, not very difficult to find oui

the minimum quantity required by the inhabitants of an;5given district; and the area of storage can then be as easilycalculated as on board ships. Constantinople, Gibraltar,and other places are partially, and Venice is wholly, sup-plied with rain-water; and PARKES, in reminding us of thefact, says that no house in Gibraltar is now allowed to bebuilt without a tank. As to the latter, we are glad again todraw attention to CREASE’S filter tanks, a sketch of which

appeared in THE LANCET, vol. ii. 1872, p. 821. These tanks

are now used in the largest ships of the Royal Navy, and

appear to us equally suitable for the storage of water onshore. It is indeed very desirable, and in fact almost neces-

sary, that every village and hamlet should have its owntank or reservoir, the proper construction and care of whiclwould devolve upon the rural sanitary authority. If thiE

plan were generally adopted, enough roof-surface exists tcafford an ample supply, even with the irregular rainfallof this country; for a correspondent of the Builder has cal.culated that on the roof of every building that covers anarea of 27 ft. by 30 ft. there falls, in the course of an ex-

ceptionally dry year, enough water for the consumption ofone adult. The construction of water tanks should be as

simple as possible. Stone, cement, brick, and slate haveall been used, the chief necessary conditions being depthrather than length or breadth, a covering, and periodicalcleansing. They should not be exposed to heat or light,and, if large, a second smaller tank should be made, intowhich the water may run through a charcoal filter.In suggesting this very simple way of storing water for

our rural population we are but inculcating a principlethat has long been adopted in other countries, where therainfall is not so intermittent as in our own, but occurs

at much longer intervals. It is possible that in many scat-tered villages a large number of small tanks would be neces-sary. But, anyhow, the reservoir system is well worthy ofconsideration at a time when the very article we speciallyrequire for the maintenance of health is, and is likely tobe, difficult to obtain in many parts of this country duringseveral months of the year.

Medical Annotations."Ne quid nimis."

THE PORT OF LONDON.

THE second half. yearly report of the Medical Officer of Healthfor the Port of London, Mr. Harry Leach, just made public, ishardly less interesting than his first report. It shows es-

pecially how all the complicated workings of the port sani-tary authority’s district are being steadily brought undersupervision, and brings more and more clearly into promi-nence the nature of the task involved in the sanitary chargeof the river and docks within the limits of the port sanitaryauthority’s jurisdiction. Mr. Harry Leach has to deal witha district not less than 88 miles in length, and of which

the topography is complicated by numerous creeks, and byeight sets of docks. Within this district there sre, on an

average, at all times stationary 1000 ships, having on boarda population of 9000 souls, while going and coming withinthe year there are no less than 25,000 vessels, exclusive of6400 sailing and dumb barges belonging to thf port. The

ordinary work of the sanitary officials of the port includesinspection of inhabited vessels with reference co cleanlinessof crews’ quarters, ventilation, closet accommodation, stateof bilges, drinking-water supply, state of water in tanksor casks, and removal of cases of contagious diseases; re-moval, if required, of vessels to isolated mocrings ; fumiga-tion of vessels; disinfection of clothing; disinfection ofeffects of sailors or others who have died at sea; inspectionof foul cargoes; examination and (under an order from ajustice of the peace) destruction of any article about to besold, or exposed for sale, unfit for the food of man; inspec.tion of dock-closets (119 in number) ; inspection of tank.boats used for the supply of water to vessels in the port;official correspondence with agents, owners, ship captains,and public departments concerned in the business of theport. In addition to these ordinary duties, special dutieshave to be performed where there is danger of importationof cholera into the port. To do this enormous amount of

work, in a district so vast, the staff of the port sanitaryauthority at the time of the writing of the report consistedof one medical officer of health, an assistant medical officerstationed at Gravesend, and one inspector. A second in-

spector has now been added, but other inspectors will ob-viously be required before the sanitary supervision of theport can be held to be fairly provided for.The ordinary work done by the medical officer of health

and his one inspector during the half-year to which thereport refers, included the inspection of 4S64 vessels, ofwhich 758 were found foul, and were ordered to be cleansed.The special work included six inspections on informationgiven by the officers of H.M. Customs, none of these in-spections happily relating to cholera. Mr. Leach has some

important observations on the future sanitary organisationof the port, a notice of which we reserve for another oc-casion.

-

SMALL-POX AT NEWMARKET.

ON the eve of going to press we are glad to be enabledauthoritatively to state that every case of small-pox at New-market has been removed to the Heath Hospital, includingthose lately located in the workhouse, and the child of anobstinate individual referred to in our special report asassisting to spread the disease in a court called 11 The

Rookery." This satisfactory clearing out has been effectedby the persevering efforts of Dr. Gray and Dr. C. Gray,under the superintendence of Dr. Armistead, medical officerof health. Six cases have occurred since the date of our

report, all of which were removed immediately to the hos-pital, and, as we write, no fresh case has occurred for eightdays. At a meeting of the magistrates held at Newmarketon Tuesday last objections were raised as to the renewal oflicences in the cases of the " Rising Sun and the "BlackHorse," it being alleged that the landlords of these houseshad by carelessness assisted the spread of the disease (oneof these cases was explained in our special report on the 8thinst.) The consideration was adjourned for three weeks inorder that special inquiries might be made. Wemayrecord,parenthetically, that a Leeds publican was fined =85 on Wed-nesday last for not closing his house against customersduring the time that some inmates had small-pox. All casesthat have occurred in the surrounding villages are eitherwell or have been taken to the hospital, so that Newmarketand its neighbourhood have, as we hope, reached the end

319

of the epidemic. The October race-meeting commences pneumonia contracted on the nineteenth day, after elevenactually in the last week in September, but, if no fresh cases days of the treatment, and one other had erysipelas of theoccur, the lospital will probably be empty by that time, face. Of other patients treated in the HÔtel Dieu by theand it must be remembered that this hospital is a mile from same method, eleven out of seventy-five died, and in privatethe course used during the race week at this particular practice five out of twenty, making in all a mortality ofmeeting. Under any circumstances, there is no reason to 16 per cent. Of these cases, one died of syncope on re-

suppose that tne Committee of the Jockey Club will disturb moval from the bath, five from pneumonia, one of facialthe hospital arrangements, and, on sanitary grounds, it would erysipelas, two of perforation, two of enterorrhagia, two ofobviously be very unwise to do so, whether at the time of diphtheritic angina, three of adynamia, and one from thethe meeting any sick remain in the establishment or not. blood condition. In addition to the fatal accidents,For all acquainted with the geography of the course know numerous complications were observed, of which bronchitis,that this old " July" stand, as it is called, now converted into broncho-pneumonia, and various forms of angina were thea hospital, need not be approached by any persons concerned most frequent. The post-mortems proved that the intestinalin the October races; and, having examined the ground and lesion proceeded unchecked by the treatment.its approaches, we have no hesitation in saying that very In contrast with the above mortality, the author hadfew towns possess, as it were ready-made, the means of iso- fifty-two other cases under his care, treated without baths,lating cases of infectious disease so completely and so suc- of which only one was fatal. He concludes that the method

cessfully, for both the letter and spirit of quarantine regu- is absolutely dangerous if used indiscriminately in all cases,lations might be carried out here in all their integrity, with and that it is only applicable in the early stage of severespecial advantages in the way of abundant supplies of pure attacks or where the fever is of adynamic type.air and water.

____

Whilst agreeing with him in these conclusions, we must-

point out that his results do not carry with them a con-TYPHOID FEVER AND COLD BATHS. demnation of the use of cold baths after a more rational

IN a recent pamphlet on this subject Dr. Bondet gives an system, such as that of Behier, which is being extensivelyaccount of some results of the employment of the so-called tried in Paris, in which the baths are given only when the"method of Brand " during the epidemic at Lyons in the temperature reaches 104°. Further details of the results

months of April and May of the present year. of the latter method are to be desired.

Our readers will remember that the disease broke out -

suddenly first at the Lyceum, and afterwards affected the DRUNK OR SOBER?lower quarters of the town, a large number of persons being THE psychology of drunkenness might afford an interest-attacked simultaneously. Dr. Bondet accounts for the ing subject for more than one article. The Broad Arrow

epidemic by the preceding atmospheric and hygienic con- of last week discusses, from a military standpoint, the diffi-ditions, noting especially the occurrence of period of high culty of deciding whether a soldier has been drunk or sober,temperature and prolonged drought, followed by a day or where the evidence is, as is so often the case, of a very con-two of very low atmospheric pressure, inefficient flushing of tradictory kind; and the matter is one capable of widerthe sewers, and the accumulation of animal and vegetable application, for the difficulty is not by any means restrictedrefuse in and around the public markets, close to which the to soldiers. As everybody knows, there are degrees ofLyceum is situated. drunkenness, and there can be no mistake about a man whoPassing next to the type and symptoms of the disease, so is 11 dead drunk," except the difficulty in some cases of dis-

important in relation to any uniform system of treatment, tinguishing between the separate or combined effects ofhe gives a careful outline of the mode of onset and course alcohol and some other poison, disease, or injury. Again,observed in the majority of cases. The onset was often when a man is noisy, incoherent, and staggers in his gait,sudden, at times more gradual, but with severe headache with the 11 smell of liquor about him," there does not remainand giddiness, epistaxis also being a constant phenomenon. much room for doubt. But it is the minor degrees of drunk-The temperature, usually high from the outset, was subject enness, and the power which some drunken men have toto irregular remissions during the day, but with an evening recover rapidly, or, by a powerful effort of self-control, toexacerbation; and inequalities of surface temperature, with act for a short time as if they were sober, that prove soirregular or localised perspirations, were common. The erup- embarrassing. A man is seen by one set of witnesses whotion on the abdomen was usually well-marked and abundant entertain, and correctly entertain, no doubt as to his beingfrom the seventh day, and a marked Mche meningitique was intoxicated; but he understands what he is about sufficientlyalmost constant ; whilst pressure in the hepatic region to be alive to the necessity of concealing his state, and, ifcaused pain, but not in the splenic. Constipation was the suddenly confronted with someone in authority, it is re-rule for the first four or five days, and was succeeded by markable how successful his efforts are in this direction,diarrhoea., at times colliquative and fetid. The temperature and how well he sustains his part for a short time. Steadyusually fell on from the twelfth to the fifteenth day. soakers, as they are termed, will go through some duty orIn the author’s cases treated at the Hôtel Dieu all the other automatically as it were, and yet have no recol-

men were given seven grains and a half of sulphate of lection afterwards of what they had done. Moreover,quinine every day, a simple or camomile injection being the rapidity with which some men recover from intoxicationalso administered daily, and the diet consisting of broth is sometimes very singular. We know of the case of anand wine. For the women was reserved the new and individual who was charged with drunkenness on the evi-experimental method, for what reason we are not told. dence of several most intelligent witnesses, and on groundsThis "method" was followed by a rigorous attention to that seemed indubitable. Within an hour or two of thatthe details recommended by its author. Its principle, we time he had undertaken some duty involving his havingmay remind our readers, consists essentially in the ad- an interview with other persons, and giving directionsministration of a bath of 68° F., continued for fifteen in writing which were quite clearly and correctly ex-

minutes, every three hours, so long as the temperature of pressed. The last-named persons came forward, to thethe patient is above normal, cold affusions being substi- great surprise of the accused, with their documentary evi-tuted after the first day or two. Of ten females thus dence in support of their own strongly-expressed convictionstreated, one had a bedsore over the sacrum, and died of that he was perfectly sober. The most curious psycho-

320

logical fact in the case was that the accused had no recol- compulsory medical inspection of seamen would be impos.lection of anything beyond the fact that on the evening in sible at the present time, because the supply would, in con-question he had been drinking hard, and he did not even sequence, at once fall short of the demand. But we insist

remember that he had seen any of these witnesses or written that this would cease to be the case if seamen were providedanything, although he was ready to swear, of course, to his with better accommodation in our coasting vessels, andown handwriting in the document. Another gentleman better diet in our ocean-going ships. These reforms, theonce assured us that he had more than once felt, after drink- application of the Contagious Diseases Acts to all mercan-ing rather freely at a dinner, the symptoms of commencing tile marine as well as Royal Navy ports, and a return to theintoxication, and that, on testing himself, he could not put system of compulsory apprenticeship would increase thetogether two consecutive sentences correctly; but, he added, supply, and then the chaff might be sifted from the wheat"I discovered that by a plentiful draught of cold water I without any fear of failure in the supply of the latter.could dilute the alcohol in my blood to such an extent as, We commend these remarks to the attention of Mr.in a short time afterwards, to make a speech, and conduct Plimsoll, believing that they have a philanthropic as wellmyself so that no one had the least suspicion of my having as a commercial and sanitary aspect.been other than perfectly sober." In vino veritas expresses -

the common belief that alcohol not only unlocks a man’s THE LOCAL COVERNMENT BOARD ANDsecrets, but causes him to disclose his true character. Such, UNION MEDICAL OFFICERS.however, is not by any means always the case. The different ’l’HE letter from Dr. Fowler, published in our issue ofcffects of different forms of alcohol on the same individual, the 22nd inst., exhibits the Local Government Board asand their very varied effects on different individuals, are actuated by a spirit of partiality and of unbusinesslikematters of common observation, of which there is no need conduct in dealing with officers deprived of their appoint-to speak. - ments through the orders of the Board. It would appear

that when the clerk to the guardians was deprived ofTHE OMISSIONS OF MR. PLIMSOLL. office by the dissolution of the East London Union, he was

THE question of unseaworthy ships is once and again permitted to claim compensation not alone for his salary,revived by the reply of the Plimsoll Committee to the final but for all the contingent advantages appertaining to hisreport of the Royal Commission. Mr. Plimsoll still con- office; but when Dr. Fowler, medical officer in the sametinues to urge the periodical survey of all vessels registered Union, was similarly deprived of his appointment, thein the United Kingdom, and to advocate the establishment of department refused to take into consideration the con-a load line for each and every vessel, and appears to believe tingent advantages (such as vaccination-fees, extra servicesthat the practice of these two principles, enunciated and during the cholera, &c.), but estimated his compensationsuperintended by Government officials, would cure most of from his stipend only. Recently it would appear that

the risks and ills to which nautical flesh is heir. The Com- superannuation has been granted to one of the medicalmission has, however, reported unfavourably as to the officers of the City of London Union, and in estimating hisadoption of either of these principles, and so, at all events claim, the computation was made not on the basis of hisuntil next session, the matter rests, when Mr. Plimsoll pro- stipend only, but on the contingent advantages as well.

poses to abide by 11 the decisive logic of a vote." This the department allowed. Hearing of this, Dr. FowlerIt has all along appeared to us somewhat strange that, in wrote and requested the department to reconsider the de-

waging war with shipowners on behalf of seamen, Mr. cision arrived at in his case. This Mr. Fleming not onlyPlimsoll did not make use of sanitary as well as archi- declined to do, but intimated in his reply that if the atten-tectural weapons. We have often pointed out during the tion of the department had been specially directed to thepast three or four years that no amount of excellence or point he had raised, they would have disallowed that partperfection in the build or outfit of a ship will render her of the claim of the medical officer of the City of Londonsafe and independent of her crew, and that if a certain per- Union. It is evident from this that the department, incentage of that crew are incompetent from disease and assessing the claims of clerks of boards of guardians, issickness, she is as likely to go to the bottom as the old tubs moved by the consideration that they have plenty of friendsthat Mr. Plimsoll so energetically condemns. We have also in the House who would take care they were justly dealtcalled attention to the sanitary objections to lower fore- with, but the parish surgeons, not having friends there, maycastles, and a most unhappy illustration of this question be trampled on with impunity.was afforded at an inquest at Barking a fortnight ago, We would advise Dr. Fowler to get the subject raisedwhen three men were found dead in their bunks, having in Parliament next session, by putting into the hands ofbeen suffocated, in abominably close quarters on a level with some honourable member a distinct question, which Dr.the cargo, by the fumes of nitrous acid gas. We have also Fowler can easily frame. ____

pointed out the necessity, and have shown the practica- ,,-bility of legalising, with certain limitations, soales of diet THE PECULIAR PEOPLE."for seamen, so that special antiscorbutics, as lime-juice, THE Law JournaZ, with a great display of learning of rivalmay be dispensed with, and the men, if they start in good sects in medicine, and of "the three classes" into which allcondition, be kept in as fair order as the spars and gear medical remedies may be divided-the 11 bromatological,that they handle. But Mr. Plimsoll seems to care for none substitutive or rather stoechiological, and toxical or poison-of these things, or fails to appreciate their importance. We ous"-expresses unfeigned delight at the recent decisionventure to think that he would have claimed the sympathy of Baron Pigott, that a father who allows his child to suffernot only of the masses, but of the underwriters and of from disease and die without seeking medical aid for it, is

many of the shipowners as well, had he devised and brought not guilty of criminal neglect. Our contemporary’s delightinto public notice some practical hints for improving the at this decision seems based rather on the slight esteem ofquality of seamen, founded on the removal of the defects the medical art which it implies than on its assertion of theabove indicated, which defects we venture to maintain have right of an ignorant parent to do what he likes with hisdeterred men from serving afloat more than the reputed or own child as far as medicine is concerned. One of his pointsactual unseaworthiness of any particular ship or ships. It is, that as medicine is so divided, one set of doctrinaireswas mentioned incidentally before the Commission that a would like to punish a parent who failed to consult what

321

they considered an orthodox practitioner. In the name of than a farce, and for all purposes of practical diagnosis issensible practitioners of medicine we repudiate any such worth nothing. The fault rests, not with the officers, but withnarrowness. We cannot think without pain of a child the system. All New Zealand emigrants are now lodged at asuffering the agonies of pericarditis for days, and finally large depot at Blackwall some days previous to embarkation,dying thereof, without having the benefit of the advice of a and a daily inspection of the inhabitants of this establish-medical practitioner recognised by the law of the country. ment should be made by the Board of Trade medical officers.It seems strange to us that the law-courts of a country The same principle should be adopted at the outport emi-which takes precautions to secure a properly educated class grant dep6ts, and, as we remarked some two years ago,of practitioners, permitting them much range of private the medical officers of the Board should have extended

opinion, should sanction the cruelty of allowing a child to duties, and be saddled with a far greater amount of re-die without the benefits of medicine. It requires a more sponsibility. -

discriminating faculty than we possess to distinguishbetween the criminality of a father who neglects to bring A CHARGE OF MALAPRAXIS.a doctor to his child with a broken leg and that of one who AN action brought last week at Liverpool against aneglects to bring a doctor to his child with an inflamed member of an old-established firm of surgeons practisingpericardium. Both events are accidents full of distress and in Chorley illustrates one of the dangers of surgicalsuffering, and both need to be most tenderly treated. Of practice. The case was one of compound fracture ofthe two, the accident to the pericardium is the more serious. both bones of the forearm in a child aged ten, which wasIt is a doctrine that we must leave to lawyers, that a child seen immediately after the accident-a fall on the hand-with such suffering may be left without medical attention. by the surgeon in question, who found the end of the boneSuch a doctrine is repugnant to humanity and common protruding, and reduced it, dressing the wound with wetsense, more worthy of barbarous tribes than of a Christian lint, which was kept in place by two strips of plaster.and civilised nation. If this really be the state of English Pasteboard splints and a bandage were applied over all, andlaw, which-Baron Pigott notwithstanding-we still doubt, the patient was driven home in the doctor’s gig. On thethe sooner it is altered the better. The medical profession evening of the next day some swelling had come on, andhas little interest in the law one way or the other, excepting the surgeon removed the bandage and readjusted it, butas a matter of humanity, and if the law has to be altered, did not interfere with the plaster. On the following day,it will have to be at the instigation of the public, and not the swelling having increased, his brother and partner wasof the profession. Meanwhile, our legal contemporary may called in, who found the hand congested. He removeddo well to extricate himself from the mazes of medical and the plaster and lint, and put on a longer splint. On the

legal theory, and contemplate for five minutes the duties of following day symptoms of gangrene showed themselves,a civilised country to a child in the agonies of pericarditis, and in the afternoon the mother took the child to a "bone-who has a father with such outrageous notions as those of setter" at Bolton, whose knowledge of surgery may bethe Peculiar People.

- gauged by the fact that he swore the fracture had beena " simple" one, with nothing but an abrasion. He, after

THE SANITARY ASPECTS OF EMIGRATION. three days, referred the case to a surgeon at Bolton, byAN energetic correspondent called 11 Bohemian " has lately whom the arm was amputated, and the child eventually

embellished the columns of The Time, with several aspects recovered.

of emigration, the point of which appears to be, that the The case turned mainly on the piece of plaster put topractice is, for the most part, a delusion and a snare. As, hold on the lint. To this all the mischief was attributed,however, emigration is a fact, and some thousands of our and the medical evidence brought forward by the plaintifffellow-creatures leave our shores every week for the pur- was based upon the hypothesis that the plaster completelypose of trying their fortunes elsewhere, proper provision encircled the limb. The defendant and his witnesses, onhas to be made for the safe transit across the seas, and the other hand, swore that half an inch intervened betweenhence we return to the sanitary aspects of emigration. the ends of the plaster, and his scientific witnesses corro-

During the past two years the Board of Trade, who now borate the view that this interval was sufficient. We do

represent the Emigration Office, have improved administra- not venture an opinion upon the subject, especially astive matters very considerably. They have increased the opportunity has been given for an application to set asidestaff and the power of the medical inspectors at the out- the verdict which was given for the plaintiff for .8150. The

ports, and are now, as we are informed, employing their danger of completely encircling a limb with either plastermedical advisers in revising the official scales of medicines or bandage cannot be exaggerated, and we are alwaysand medical stores, which had become absurdly antiquated reminded, when hearing of such cases, of the formidableand complicated. So far, so good. But, as it appears to us, illustration introduced into "Miller’s Surgery" with thesome laxity exists as to the medical examination of emi- grimly ironic description-" Gangrene from strangulation ofgrants before or at the time of embarkation. It is notorious an injured limb by absurd bandaging. John Bell. Intro-

that a large number of children have been sent on shore at duced on a large scale in terrorem." Most surgical authorsGravesend suffering from measles, whooping-cough, or some refer to the subject,.and deprecate any bandaging of aother contagious or infectious disease, from large emigrant fractured limb, and it is therefore a matter of regret to usships bound for New Zealand, and it is equally notorious to find that even in the last edition of Druitt’s well-knownthat several New Zealand ships have arrived in that colony "Surgeon’s Vade-mecum" the custom is upheld with

having had during the outward passage a serious amount apparent approval, as follows:—" It is usual to bandageof mortality on account of these diseases. We recommend the whole of the fractured limb from its extremity. Thisthese facts to the serious attention of the Board of Trade, is done for the double purpose of preventing swelling andTheir medical staff, both in London and at the outports, is of confining the muscles that they may not contract andnumerically weak. It is eminently necessary that a careful disturb the fracture. But it is unnecessary." We wouldexamination of all emigrants about to embark for a long add-and to be avoided as dangerous.

_

voyage should be made on shore, for the superficial (and we Given a case of congested limb with threatened gangrene,believe the only) inspection that takes place an hour or two much may be done to relieve the part, and obviate mischief

previous to the final departure of the vessel is little better by careful friction with the hand in the direction of the

322

venous circulation, and by raising the part. Nothing of borough. In Birmingham, indeed, Dr. Buchanan believesthis kind seems to have been attempted by the "bone- that a large remainder of the disease has still to come, un-setter," who allowed the limb to be for three days without less the sanitary authority of the borough bestirs itself inany proper support before he referred the case to a qualified measures of repression in a different fashion from what it hassurgeon. ____

done up to the present time. Now, making every allowance-

for the means taken as to vaccination and revaccinationHEALTH OF B RICHTON. in limiting the spread of small-pox, Dr. Buchanan believes

THE medical officer of health for Brighton, Dr. Taaffe, has that these alone will not account for the decline of the out-

issued his report for the quarter ending June 30th. During breaks in London and Coventry at particular periods. He

the three months 703 births and 425 deaths were registered thinks that the hospital accommodation provided contri.in the borough. Of the latter, 48 were those of non-re- buted in a most marked and efficient manner to this end.

sidents, and excluding which the mortality of the town is In both places hospital accommodation for small-pox wasreduced to the low annual rate of 16-8 deaths per 1000. We provided at the rate of seven or eight beds per 10,000 ofquite agree with Dr. Taaffe, that as a great number of the population, and all classes of the population made use ofpersons go to Brighton very ill, and in much greater pro- this accommodation. When the hospital accommodationportion than the residents who leave the town in the same had reached this amount, and was brought into free use, thecondition to seek restoration to health elsewhere, it is only outbreaks rapidly declined and died out. In Birmingham,fair that a proportionate reduction in the death-rate should during the whole three years (1871-73) over which thebe made for non-residents who die in the town. The most present outbreak has been dragging, the hospital accom.fatal of the zymotic diseases during the quarter was whoop- modation never amounted to three beds per 10,000, anding-cough, which caused 18 deaths. Measles was accredited these beds, moreover (differing in this respect from thewith 14 deaths. We observe that no death occurred either course taken in London and Coventry), although open infrom small-pox or scarlatina. The immunity of Brighton 1872 to non-pauper cases, were provided for paupers, andfrom the latter disease at a time when it is so widely pre- not appreciably used by any but paupers. Birminghamvalent throughout the whole country is singular. The deaths has yet to learn the advantage of other than pauper hosereferred to phthisis and disease of the respiratory organs pital accommodation in these contingencies.amounted to 117, or 27’5 of the total mortality. There were -

21 deaths from cancer, 2 from alcoholism, 32 from heart PROFESSOR CRANT F.R.S.disease, and 3 (infantile) from congenital syphilis. A house-

rrtUf&BnL tunri ) , r.n.B.

to-house visitation was made in the poorer neighbourhoods WE regret to have to announce the death, on Sunday last,of the town by the inspectors of nuisances, who do not from an attack of diarrhoea, of Dr. R. E. Grant, F.R.S., Pro-

appear to have found, as a rule, much to condemn. We fessor of Comparative Anatomy and Zoology in Universitycannot refrain from congratulating Dr. Taaffe and the College, London. A graduate of the University of Edin-

sanitary authorities on the manifest salubrity of Brighton. burgh in 1814, he was appointed, at the foundation of Uni-- versity College in 1828, to the chair which he held up to

SMALL-POX AT BIRMINCHAM. the time of his death. His reputation rested chiefly uponscientific work done in his early life. His lectures were

THE Birmingham papers publish a report by Dr. clear and full of information, and even eloquent, deliveredBuchanan, one of the assistant medical officers of the Local with all the earnestness of an enthusiastic lover of hisGovernment Board, on the prevalence of small-pox and science. He was, as Prof. Tyndall remarked the other dayother infectious diseases in Birmingham and Aston, and on at Belfast, one of those who earliest embraced the ideas ofhospital accommodation there. This report, while dealing development of which Darwin became the subsequent expo-with the necessity of the moment as to hospital accommo- nent, and was far ahead of his earlier contemporaries, almostdation, also discusses the requirements of Birmingham with more than abreast of advanced thinkers of the present dayrespect to permanent hospital accommodation for infectious in the wider theories of science. Possessed of an equablediseases. Postponing for the present the question raised by temperament and good health, with a nature open to allDr. Buchanan of the permanent hospital accommodation sources of enjoyment from art, music, and literature, hewhich should be provided in towns in view of limiting the passed, with much quiet happiness, through a solitary lifespread of infectious diseases, we shall now restrict our which was not without its privations ; and even the con-observations to such portions of his report as refer to the sciousness of impending death did not lessen his keeninfluence of hospital accommodation in checking outbreaks interest in the subjects to which he was devoted. He wasof small-pox. Dr. Buchanan furnishes data on this head, the only surviving professor at University College who waswhich have not been accessible before, and which cannot be appointed at its foundation to the chair which he still held.too widely known. He shows how, with respect to per- ____

sistent outbreaks of small-pox, that the short duration of -

the late outbreaks in London and Coventry, as compared NEW RESEARCHES ON DIABETES.

with the outbreak still in progress, in Birmingham, was WE learn that Dr. Pavy has obtained some experimentalin all probability due to the larger amount of hos- results which are likely to throw a new light on the subjectpital accommodation provided in the two former places. of diabetes. He has found that the injection of defibrinatedSmall-pox was seriously epidemic in London for seven con- arterial blood into the portal system occasions a saccharinesecutive quarters in 1870-72, but by the end of 1872 the state of the urine. In one experiment, the urine after thedisease had diminished to very small proportions. It was operation contained fifteen grains of sugar to the fluidstill more seriously epidemic in Coventry for six quarters of ounce, and in others the quantity has amounted to nearly1871-72, and then in the middle of 1872 was almost sud- the same. In the counterpart experiment of injectingdenly and totally extinguished. But in Birmingham it was defibrinated venous blood into the portal system, the urinemildly epidemic for five consecutive quarters of 1871-72; showed no signs of the presence of sugar. It thus appearswas still prevalent, though less so, throughout 1883 ; and that oxygenated blood passing to the liver causes an escapenow, in 1874, when London and Coventry are free from the of sugar from the organ, and thence an accumulation in thedisease, Birmingham is suffering under a sharper visitation system and discharge with the urine. It also appearsof it than at any former period since it first appeared in the that through the medium of the respiration of oxygen he

323

has succeeded in inducing a sufficiently oxygenated state of Whitechapel district will be supplied on the constant-servicethe blood to similarly give rise to the production of sac- system, that all butts and cisterns will be abolished, andcharine urine. He has further found that through the that the inhabitants will be enabled at all hours to procureagency of the inhalation of puff-ball smoke an immediate a glass of pure and cool water direct from the main. Weand strongly diabetic state may be induced, and that the congratulate the medical officer of health for the well-effect is accompanied with such a modification of the circu- known zeal and energy with which he has conducted thislation that the blood flows through the vessels, as is the very important sanitary reform in his own district.case after section of the sympathetic, without becoming -

properly de-arterialised. His experiments, he considers, AMATEUR CONJURINC.suggest that, in diabetes of the human subject, the blood, in IN the course of an investigation held last Saturday at the°°

.. , ..’ -i. i N the course 0 an investigation held last Saturday at the

consequence of vaiio-muscular paralysis, is allowed to reach London Hospital into the cause of the death of a boy agedthe portal vein in an imperfectly de-arterialised condition, particulars came to light. It wouldthe , . ,*- ". .,,. -rn. six years, some curious particulars came to light. It wouldand thus determines the escape of sugar from the liver. We appear that a favourite amusement with the juvenile popu-understand his results are to be brought forward at the lation of Bethnal-green is the practice of pushing glassRoyal Society as soon as its meetings commence. beads into their ears with the delusive pretence of being

-

able to withdraw them through the mouth. On Friday, theDICESTION AND ABSORPTION IN THE LARGE 24th ult., the lad in question attempted the trick, with the

INTESTINE OF MAN. result of firmly embedding a bead in his left ear. On theCZERNY and Latschenberger have lately had the oppor- next day he was removed to the London Hospital, where the

tunity of examining the physiological processes taking place bead was, after considerable trouble, extracted. The boy,in the large intestine, in a case in which the inferior seg- however, died on the following Wednesday, and a post-ment of the alimentary canal, corresponding to 11 length of mortem examination revealed the fact that extensive inflam-about 12 inches, was not continuous with the upper part. mation of the brain had taken place. It also transpiredThe absorbing surface was estimated at about 240 square during the inquest that five other cases of injury to the earcentimetres, and the cubic contents at 154-5 cubic centi- produced by manipulating beads in the organ had beenmetres. Under pressure of a column of water 40 centimetres treated by the officers of the hospital. The jury veryin height the portion of intestine would contain about naturally wished these facts to be made public, and so serve200 cubic centimetres. The method of research consisted as a warning to parents and children.in introducing the fluid or other substance to be examined ____

into the upper opening through a caoutchouctube, and after HOUSE OF REST FOR OVERWORKED NURSES.

a determinate time again withdrawing it by aspiration, and WE understand that it is contemplated to establish at washing out the cavity with pure water. A comparison was Harrow a home of temporary rest for trained nurses, andthen made between the fluid injected and that withdrawn. Harrow a home of temporary rest for trained nurses, andIn the researches on digestion sharp-angled fragments of that a lady living in the neighbourhood has undertaken toalbumen were introduced, but neither these nor portions of and £80 a year towards the support of such an institution,fibrin exhibited any indications of having undergone and to be responsible for its management. It is not lll-digestion, and there was no formation of peptones. Fat was tended to be in any sense a hospital, but a means of rest and

not emulsified, nor was starch converted into sugar. recreation for nurses whose health has broken down underEven after a period of two months and a half, pieces of continued work. It will to a certain extent be self-support-

albumen were only eroded at the and a half, regard to ing, as a sum of 7s. a week will be required of each inmatealbumen were only eroded at the edges. In regard to for maintenance, but the power of modifying this rate inabsorption, about 40 or 50 grammes of water were absorbed for mallltenance, "... but the power of modifying this rate inin about seven hours. The albumen of the egg, if in a state exceptional circumstances will be reserved. We wish theof solution, could also be absorbed to a considerable extent. scheme every success. The London and Westminster Bank

The addition could common salt materially prevented absorp- has opened an account for subscriptions, which are to beThe addition of common salt materially prevented absorp- made payable i.,. Harrow,tion of the albumen, and -c much were added the intestine

made payable to Miss Catherine Whitehead, Harrow.tion of the albumen, and if much were added the intestine ma e 0 ISS a erlne 1 e ea, arrow.

contained more fluid than before, as a process of exosmose THE WINDSOR CASTLE DRAINAGE.

was established. Both fat and starch paste underwent THE WINDSOR CASTLE DRAIN ACE.

absorption to some though not to any very great extent. SOME two years ago this topic formed the subject of aIn twenty-four hours only 90 grains of albumen could be special report in THE LANCET. It is sufficient just now toabsorbed at most, a quantity wholly insufficient to support remind our readers that what is called the separate systemlife. was adopted in the construction of these works, and we are

-

enabled to report that the results have been eminentlySANITARY NOTES. satisfactory, thanks to the skill and energy of Mr. Menzies,

MR. J. LIDDLE has just issued his annual Report on the the deputy ranger of Windsor Forest and Park. The

sanitary condition of Whitechapel, for which district he is drainage works of Eton are being constructed on the samemedical officer of health. The most important part of Mr. system, and we hope two or three weeks hence to give aLiddle’s report is that which relates to the constant-service résumé of the works accomplished in both cases, as a possiblesystem of water-supply, which is being gradually introduced guide to those sanitary authorities who are now in a chaosinto his district, and the northern part of which is sup- of cloud and despondency as to the disposal and utilisationplied by the East London Waterworks Company. The cost of their sewage. ____

to the owners of houses in making the alterations rangesfrom Ts. 6c!. upwards, according to the amount of piping THE HOP-PICKERS.

required; but the gross cost is not nearly so much as was As we write, from 28,000 to 30,000 persons of both sexesanticipated. 11 Screw-down" taps are in general use, and and all ages have migrated from various parts of thein a short time every house in the district where a constant country, but chiefly from London, into Kent, Surrey, andsupply is given will be provided with a stop-cock, fixed in Sussex. We have during the last three or four years per-the street, so that the occupiers can turn off the water with- sistently directed attention to the very insanitary conditionsout difficulty when repairs are required. Mr. Liddle states under which these labourers perform their work, and to thethat, at or about the end of next year, the whole of the fruitful foci that they present for the origination and

324

elaboration of epidemic diseases. Time was, and not so long MR. TATHAM, medical officer of health for Salford, reportsago, when the scenes of indecency and immorality that that the death-rate of the town for the past year was 2918occurred among these temporary inhabitants of some of the per 1000. The period was marked by a lengthened visita-fairest counties in England were unparalleled in their in- tion of measles, which does not, however, account for the

tensity, and a vast amount of room still exists for improve- high rate of mortality which prevailed. Although Mr.ment. There are, as with shipowners, a number of hop- Tatham is supplied by many medical practitioners withgrowers on a large scale who provide for the sanitary safety information as to cases of infectious disease coming underof their employés, but a vast number of small holders exist, their treatment, he is convinced that these returns do not

who, like the possessors of the small coasting craft, either represent a tenth part of the disease which actually occurswill not or cannot look after the well-being of their servants. in the town, and of which he has no means of obtainingWe are curious to know how a clause on this subject that knowledge. A large amount of good sanitary work washas been introduced into the Sanitary Laws Amendment performed during the year, including the demolition ofAct will work, and how far it will be influenced by the local fever dens, the closing of cellar dwellings, and the removalinterests and proclivities of rural sanitary authorities. of midden cesspools. The river Irwell would appear to be

.-- in a very offensive and dangerous condition, and unfor-HYCIENE AFLOAT. tunately there is no immediate prospect of preventing its

SOME weeks ago we called the attention of our readers to pollution.

-

the fact that men working in the Royal dockyards between A RECENT circular from Port Said states that there is nothe double bottoms of armour-plated ships were frequently longer any doubt that the plague has broken out in Arabiaaffected with symptoms of lead-poisoning. It appears that (in Assyr), and the Egyptian sanitary authorities haveduring the past few months several cases of this kind have subjected an Austrian steamer, the Oreste, to twenty-oneoccurred in Chatham Dockyard. Dr. Jack, R.N., the surgeon days’ quarantine at a place called El-Wedg, ten miles fromin charge, has recommended that each man employed in this Suez. This steamer arrived from Jeddah and Hodeidahkind of work shall be furnished with a relay of canvas suits, some five days ago, having left those ports just as someas it is evident that much of the lead used clings to the cases of the plague had occurred. This is of considerablemen’s clothes, and so increases the danger. importance to a portion of the steam shipping interest, as

-

it will to a great extent interfere with the MahommedanTHE Board of Visitors appointed for the present year to pilgrimage to Mecca this season, which is a source of profit

inspect the Royal Military Academy, Woolwich, report to certain companies who carry the pilgrims from the farfavourably of the health of the cadets and of the sanitary East and from the Mediterranean and Black Sea to Jeddahstate of the buildings. There have been a few cases of and vice versd.

____

measles, not, however, attributable to defective hygienic -

arrangements. The medical officer has again directed atten- WE are pained to learn that among the batch of prisonerstion to the want of covered communication between the who were atrociously butchered by the Carlists a few weekssleeping rooms and the baths in parts of the buildings, but ago was an unfortunate member of our profession. When

the Board do not supplement his request, and are, moreover, will the civilised European powers put a stop to the fratri-of opinion that cadets likely to suffer from such exposure as cidal and revolting war now going on in Spain F Not, to allthat complained of are not suited for a military life. The appearances, until a few more newspaper correspondents arewant of a spacious recreation ground seems to be acutely shot.

____

felt at the Woolwich Academy.LORD STRAFFORD has offered to defray the cost of erection

THE Empress of Austria visited Bethlehem Hospital on of a house in the eighth block of the Ventnor ConsumptionTuesday last, and was conducted over the institution by Hospital, which, when built, will make the entire range ofDr. Rhys Williams, the able and well-known resident phy- buildings complete. This house is to be called "Lady Agnessician. Her Majesty visited all the wards, and conversed Byng’s Hospital," in memory of the Earl’s first wife, fifthwith many of the patients, both male and female. The daughter of the late Marquis of Anglesey.Empress spent two hours in the hospital, and on leaving —

expressed the great gratification she had derived from her IN London 1303 deaths were registered last week, in-visit. We are pleased to learn that Her Majesty has since eluding 23 from measles, 62 from scarlet fever, 26 fromsent Dr. Williams a very handsome set of studs as a souvenir whooping-cougb, 32 from different forms of fever, and 166of her visit, and also given .820 to be distributed amongst from diarrhoea. No death from small-pox was recorded.the attendants of the hospital. It will be seen that the mortality from diarrhoea is rapidly

declining.OUR analysts are recommended by their brethren in Scot-

declining. ____

land to look after soda-water. Dr. Wallace, of Glasgow, THE result of the important case of Jay v. the Greshamfound lead in the proportion of 9-100ths of a grain per Life Insurance Office, tried at the recent assizes at Leeds,

gallon in a bottle submitted to him for analysis, which is not such as to encourage insurance offices to questionprobably caused symptoms of lead-poisoning in a lady who their liability to pay after death the amount insured. We

had been advised to drink soda-water freely, and who had shall consider the questions involved in more detail nextindulged in this presumably harmless fluid to the extent of week.

--

six or seven bottles a day. ____ WE learn that a Bowing Club has been formed at theWE learn that a Rowing Club has been formed at the

WE understand that the statue of Her Majesty, the arrival London Hospital, which has received the most active sup-of which at St. Thomas’s Hospital we noted last week, and port of both staff and students, Dr. Andrew Clark beingwhich has been temporarily erected in the central hall of president.the building, will not remain in its present position, which

-

is found to be unsuitable, owing to the low pitch of the DURING the voyage of the emigrant ship City of A delaide, ceiling and the defective lighting; and it will, therefore, which lately got aground on Henley Beach, near Adelaide,be placed in the well of the central staircase. eight deaths from scarlet fever occurred on board.